The placebo element in Bach flower therapy

A review of seven published studies (Ernst 2010) states that “the most reliable clinical trials do not show any differences between flower remedies and placebos”. The validity of these results could be questioned, because clinical trial design inevitably distorts the way the Bach system is used, for example by giving all subjects a standard mixture instead of letting them take part in selecting their own combination of remedies. But in any case, considering that the remedies do help a majority of the clients seen in real life practice, does it really matter if they are “just placebo”?

Maybe it is time to replace the term “placebo” because of its negative connotations. At worst, it conjures up an image of dishonest charlatans charging fat fees for giving sugar pills to neurotic women with imaginary ills. But research has shown that a placebo element is involved in every intervention, including orthodox medical and surgical treatments as well as complementary and alternative therapies, and for “real” diseases as well as functional symptoms. By stimulating the body’s own self-healing capacity, with no risk of side effects, the placebo effect can be a powerful force for good.

Bach flower treatment could mobilise the placebo effect in several ways:

  • Through deciding to explore a new therapy that is natural, gentle and pleasant to use, clients experience positive expectations and a sense of choice and control.
  • Talking in a relaxed setting with a practitioner who is empathic and non-judgmental is therapeutic.
  • Analysing specific negative emotions and attitudes according to the Bach system offers a new way of understanding problems.
  • Taking the remedies four times daily provides a reminder of the positive feelings they are designed to instill.

Image: White Chestnut, a remedy for worrying thoughts.

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Two churches

This morning I attended 11 a.m. Mass at St Patrick’s Cathedral in Auckland, as I have done almost every Sunday morning for seventeen years. Being a member of the choir, I watch the proceedings from up in the organ loft.

cathedral mass

Services at St Patrick’s are traditional, based on the same format that has been used for centuries in Catholic churches all over the world. In the choir we mostly sing classical four-part motets, in either English or Latin; today’s programme included Call to Remembrance (Farrant), O Lord Increase my Faith (Gibbons) and Ave Verum Corpus (Elgar). Singing such pieces requires concentration, but there is also time to appreciate the beauty of the liturgy and the music, and the prayerful atmosphere of the setting.

After a brief lunch break I walked up the road to St Matthews in the City for a very different experience at the annual Blessing of the Animals service organised by the SPCA. The church was packed with people and animals, mostly dogs, some of them extremely active and vocal. The programme of hymns, songs from a school choir, poems and talks was mainly cheerful, though some aspects – lighting a candle for pets who have died, and prayers for animals who suffer abuse – were quite emotional.

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It is said there are many spiritual paths, all equally valid. Today’s two services could hardly have been more different, but both were uplifting.

 

Bach flower remedies and orthodox psychiatry: a comparison

After working as a psychiatrist in England, I became a Bach flower practitioner in New Zealand. The Bach flower remedies are a long-established complementary therapy intended to improve emotional balance. While not an adequate treatment for serious forms of mental illness, they can be used for the same sort of problems – anxiety and phobias, mild to moderate depression, responses to loss or stress, adjustment reactions, relationship difficulties – that often present in mental healthcare settings. Without a clinical trial, it would be impossible to say whether Bach flower therapy, orthodox psychiatric treatment or a combination of both works best. There are several points of contrast between the two approaches, as outlined below.

The style of interview: The traditional psychiatric interview and mental state examination involves asking patients a great many questions, covering not only the detail of their present complaints, but also their life history and social circumstances. This elicits a great deal of information, some of which may be highly relevant for future management, but some patients may find it intrusive or feel it does not allow them enough time to express their real concerns. A Bach consultation, in contrast, is more exclusively focused on current emotional state, and it is up to the clients to reveal as much or as little as they wish. Practitioners may ask for clarification, but do not probe too deeply – a key word is Simplicity. I believe this is more relaxing and therapeutic for those on the receiving end, however it may mean that important material – for example symptoms of a medical disorder, or suicidal ideation – is missed.

The diagnostic assessment: Psychiatrists assign their cases to a diagnostic category from the official classification systems, ICD or DSM. These categorisations are valuable in enabling research into the causes and treatments for different conditions. Bach practitioners, in contrast, make little or no use of diagnostic groups but aim to understand exactly what negative emotions the individual is currently experiencing; for example the same client might be feeling fear for no apparent reason, combined with regrets about the past and lack of confidence to apply for a new job.

Medication: A great advantage of Bach flower remedies over psychotropic drugs is their lack of side effects or interactions. They can also be more accurately tailored to the individual case, as up to six of the 38 flowers can be mixed together, giving rise to multiple possible combinations; suitable remedies for the fictional client described above would be Aspen, Honeysuckle and Larch. The key question is whether they work? Many authorities are sceptical, given that their mode of action is obscure and that most  published trials have shown no significant advantage over placebo. However most of the trials have not used the remedies correctly, having given all subjects the same mixture rather than individual prescriptions chosen at interview. The lack of scientific validation stands in contrast to the worldwide popularity of the therapy, still continuing 90 years since it was first developed by Dr Edward Bach. I have found that about 80% of clients respond well, a success rate comparable to that seen with psychotropic drugs. I have not been able to find any randomised trials comparing Bach flowers with antidepressants or anxiolytics, and would be pleased to hear of any that I have missed.

Relationship with patients/clients: While doctor-patient relationships are no longer so authoritarian as in the past, the doctor (or other orthodox clinician) is in charge, the patient has a passive role, and there are firm professional boundaries. With Bach flower treatment there is a more informal and egalitarian relationship, with clients being encouraged to take part in choosing the remedies they need. I have never found this familiarity abused, having had many friends as clients, and clients who have become friends. It is stated in the Bach Foundation code of practice that clients remain responsible for their own well-being, and I believe this self-responsibility contributes to the success of the treatment – though it would not be appropriate for cases of severe psychiatric illness, which should not be treated solely by Bach flowers in any case.

Psychological treatments: In mental health settings, a range of psychotherapeutic techniques may be used either alongside or instead of drugs. Formal psychotherapy is not part of Bach flower treatment, although all practitioners need basic counselling skills, and some are qualified to use other methods that can successfully be combined with the flowers – I have used my life coaching training in this way.

Professional support: Clinicians working in a public health service are obliged to interact with colleagues, fulfil requirements for audit and continuing education, and attend meetings. All this helps with maintaining standards and keeping up-to-date, though can divert time and energy from direct patient care. In contrast, Bach flower practitioners often work in isolation and are not strictly regulated. They have more time and energy for their clients, and are very unlikely to cause them direct harm, but there is some risk they may fail to recognise a serious mental or physical disorder that needs prompt medical assessment.

A few psychiatrists around the world already use Bach flowers in their practice, and there seems no reason why these remedies could not be more widely integrated with orthodox treatments.

 

 

Walking for the animals

Following on from Zumba Gold and cold water swimming, my exercise challenge for today was a brisk walk in the Auckland suburb of Hobsonville. I did this partly for health benefits but more importantly to raise awareness for my favourite charity, the Society for Prevention of Cruelty to Animals or SPCA. A group of supporters, many with their dogs, gathered at the site where a new centre serving the North Shore area is to be built next year. Brian came too.

Although there are plenty of animal lovers in New Zealand, there are also many cases of cruelty and neglect. I know from my years of volunteering with the SPCA that the organisation does wonderful work in rescuing, rehabilitating and rehoming animals, educating school children about animal welfare, running low-cost desexing programs to prevent litters of unwanted kittens, seeking justice in cases of animal abuse, and more.

Until now the SPCA has operated from the Animal Village in Mangere in South Auckland, close to the airport. As the city’s population has grown, not only are these premises too small, but traffic congestion is making it very difficult to service the area efficiently. The new centre in Hobsonville will make it possible to help many more animals such as my own beautiful Magic (pictured), who was brought into the SPCA as the only survivor of a litter of kittens left to die under a hedge. More funds are still needed to build the centre and donations can be made through https://www.spcaauckland.org.nz.

Magic on cyclamen bed

 

 

 

Style after 70

With spring on the way, this feels like a good time to sort out my wardrobe. Despite my policy of giving away one garment whenever I get a new one, I have too many clothes and some of them no longer seem suitable.

Circumstances, priorities and bodies change with advancing age, often calling for adaptations in dress style. Some older women become more adventurous and frivolous, following the latest fashion trends or putting purple highlights in their hair. Some stick to a safe formula such as wearing only black, white or navy blue. Some have clearly lost all interest in their appearance, and opt for the comfort and convenience of old tracksuits. Personally I have become rather more conservative, aspiring to a simple practical and classic look, and hoping to avoid any impression of “mutton dressed as lamb”. So all my shorts and jeans, and anything too brightly coloured, will be going to the charity shop.

But other superfluous garments are hard to part with. Some have sentimental value because they were given to me by someone I care about, or bring back memories of a special occasion. Some that were quite expensive to buy have become faded and out of date, having languished too long in the cupboard being “saved for best” and hardly ever worn. Some are old favourites that I still wear a lot, but probably shouldn’t because they look awful if I happen to see them in a photo of myself. Others simply “might come in”. I suppose it is an exercise in letting go of the past and I could apply Marie Kondo’s advice to “keep only clothes that bring you joy”, as described in her book The Life-Changing Magic of Tidying Up.

My long-held ideal is having a wardrobe planned according to a logical system: a certain number of clothes of each type for each season, all colour-coordinated of course. Despite many attempts over the years I have never quite managed to achieve this. Fashion – and life – is always changing, and can never be perfect.

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Cold water swimming

Inspired by Floating, Joe Minihane’s memoir about swimming in seas, rivers and lidos around the UK, I plan to do more outdoor swimming this year. I have ample opportunity here in New Zealand, being lucky enough to live in a house with a pool in the garden and ten minutes walk from the sea. I already swim most days during the hot summer months but intend to try extending the season.

Swimming, especially in cold water and sea water, seems to confer mental and physical health benefits over and above those to be gained from exercise in general. Mechanisms for this include the physiological stimulation of being in cold water, the meditative state induced by rhythmic movement and deep breathing, being surrounded by nature, and absorption of the minerals present in the sea. Many people feel an immediate uplift of mood and energy when they go for a swim. Regular swimming over a period of several months appears to reduce stress, helps to regulate the immune and endocrine systems, and reduces inflammation. Regular swimmers catch fewer colds, and there is preliminary evidence that swimming can help in the management of numerous medical disorders including anxiety and depression, eczema and psoriasis, hypertension and diabetes. However it takes time for the body to adapt to the demands of cold water swimming and reap these health benefits. So it is important to build up the practice gradually, and to be aware of the potential hazards as outlined below.

The shock of getting into cold water can throw all body systems out of balance, causing the sudden onset of breathing difficulties, muscle spasms, raised blood pressure and disordered heart rhythm. Cold water shock can be fatal due to a heart attack, stroke or inhalation of water. Hypothermia can ensue after more prolonged immersion and is manifest by shaking, weakness and confusion. To avoid hypothermia it is important to wrap up and warm up after the swim. Individual tolerance to cold varies but my understanding from various websites is that water temperatures below 15C are always dangerous, and that beginners should probably not start below 20C. Wild swimming in rivers or seas carries the risks of infections, injuries, and drownings due to powerful currents or tides.

Being a person who gets cold easily I considered buying a wetsuit, but after a trial fitting decided against it. I found the suit so cumbersome to take on and off, and so constricting to wear, that I felt it would detract from the pleasure and benefit of swimming. I got leggings and a neoprene jacket instead and am proud to report that yesterday, the last day of winter, managed to swim one length of the pool …

J contemplating water

Stranger than fiction

Good fortune can come about in the most unexpected ways: coincidence and synchronicity that seem too remarkable to be due to chance, “lucky mistakes” that seem devastating at first but work out for the best. Evidence for a higher intelligence orchestrating our lives, or just random quirks of fate? These examples from my own experience range from the trivial to the life-changing.

The car ferry

Last week we visited the Bay of Islands, some hours’ drive north of our home in Auckland, and took the car ferry between Russell and Opua. I was parked at the front of the side row. Although I thought I had followed the attendant’s guidance, she warned me I was too close to a metal bar on the boat and would probably scrape against it on the way out, because with other cars packed so close I would not be able to reverse. I felt increasingly upset and anxious as the voyage progressed. But then, at the​ end of the crossing, the car next to mine failed to start. The vehicles behind had to reverse to get round it, giving me room to get clear of the obstruction. Meanwhile, shore staff had come on board with jump leads and restarted the stalled car.

The Italian jug

A few years ago, when I was preparing to publish my first novel Carmen’s Roses, I came home to find an unfamiliar jug being washed in the kitchen sink. My husband had picked it up from the pile of rubbish awaiting the annual “inorganic collection” from the pavement of our street. It was white, decorated with swirls of blue and orange, and had Made in Italy written on the bottom. I was delighted and amazed, because a similar jug plays a key part in the plot of my novel, and unknown to my husband I had been searching for a relevant image for the cover. A photo of the jug now features in both the two versions of the cover, on Amazon and Smashwords.

Long-lost family

My last example is more significant. Last year, after my mother died, I felt free to seek information about the father I never knew. A friend with an interest in genealogy posted an online inquiry on my behalf. The synchronicity was that a member of my father’s “other” family was searching the same website at the same time. The lucky mistake was that my friend had got my mother’s name wrong and, for reasons too complicated to explain here, it was only because of this that the connection was made. Though my father himself is long dead, I have since found out about his life, and had successful meetings with my “new” relatives in the UK.

 

 

 

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